Developing methods of evaluation appropriate to undergraduate teaching in general practice at Glasgow University
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University of Glasgow
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A thesis submitted to the Department of General Practice for the award of the degree of Doctor of Philosophy of University of Glasgow
The teaching of general practice in the undergraduate medical curriculum now takes place in all medical schools in the United Kingdom. The main expansion has taken place after the Report of the Royal Commission on Medical Education in 1968. The teaching in general practice was introduced into already crowded curricula and it has therefore been important to justify this teaching. The developments at each University have been dependent on the local circumstances and this has led to a variety of teaching methods. The need for general practice teaching is discussed and this is followed by a description of the present teaching at all the Universities in the United Kingdom. Methods of evaluation have undergone recent changes and the methods used in this thesis are those that are accepted by educationalist. The undergraduate teaching of general practice presents difficulties in an evaluation. Firstly with the teaching being new, the literature is sparse on the subject and guide-lines are difficult to find. Secondly, almost all the teaching is carried out by full-time general practitioners; the students are in groups of two or four and observational data is impossible to obtain without a large team of evaluators. Thirdly, the teaching of general practice at present is not subjected to traditional examination techniques and therefore data cannot be compiled from that source. Traditional evaluation depended on measurable data and it is this which has had most criticism because it is too restrictive and misses the complexity of the teaching/learning situation. The current approaches give a more global view of the teaching but all evaluation procedures have advantages and disadvantages. In the present study a number of approaches have been used, utilising the advantages of the different methods and recognising some of the disadvantages. The teaching of general practice in Glasgow was expending during the time of study; some parts were developing while others were an established part of the teaching and these factors had to be taken in account when choosing methods of evaluation. The teaching in third year, when the student is present at a patient's initia1 consultation in a new illness, was introduced at the beginning of the present study. A pilot study was carried out to determine the feasibility and desirability of this teaching. As a result of this, the teaching was given in the following academic year to the majority of students in the year. Further evaluation was carried out and as a result this teaching is now an accepted part of the curriculum. Any innovation in general practice teaching in Glasgow will continue to be assessed in this way and will not be introduced into the curriculum unless it adds a further dimension to the hospital teaching. The opinions of both students and tutors are sought early and any alterations can be introduced at an early stage. The teaching in fourth year, the long-term care of the chronic sick, is an accepted part of the curriculum and the introduction of recording booklets allowed the teaching to be standardised and both the teaching and the students to be evaluated. The teaching in fifth year was at an early stage at the beginning of the present study and the methods chosen for evaluation were similar to those used in third year. The Department of General Practice in Glasgow introduced to the teaching of medical students the technology of a computer. This study was part of a National Programme and was an innovation in a British medical school. This new teaching method was evaluated and the print-outs of the students' performance which the computer could provide gave an additional method of evaluation. Computer-assisted learning is now being used in other Departments in the medical school and the teaching materia1 and methods are being transferred to other Universities. This teaching method has considerable application. In medicine and further development will continue. Any teaching method using high technology can be difficult to justify on an economic basis but in medicine with the high cost of training a doctor, this teaching can be cost-effective. The collaborative teaching with the hospital departments is at an early stage and seems to form a useful addition to the hospital teaching. This will expand and probably involve other disciplines. The senior elective as a formal part of the course was introduced for the first time during the period of evaluation. Although the number of students was limited, the format and the variety of practices have been appreciated. The tutor force continued to grow throughout the period of the study and a significant number of the general practitioners in the Glasgow area are now involved in this teaching. This large number of tutors creates problems in the uniformity of methods and standardisation of teaching. There are regular meetings with the tutors and evaluation data is presented with each tutor being given his own data when he is able to compare this to that of the group. These meetings with visits to the general practitioners in their own surgeries have helped to create a unity of purpose. The questionnaire to the University teachers of general practice in other centres and to the Glasgow tutors has shown that there is a greater uniformity of opinion about general practice teaching than had been realised. There was also little difference between the full-time University teachers and the part-time tutors in their opinions about teaching. In the teaching in third and fifth year, a record was kept of all the teaching consultations. This provided a record of conditions seen and allowed a comparison with the corresponding morbidity in a general practice situation. The student learning was measured in the third year and the opinions of those concerned were sought in both years. The detailed marking of the recording booklets and the computer print-outs provided the main basis for the evaluation in fourth year. The elective period was evaluated using a questionnaire and the tutors' opinions were gathered in each part of the teaching. The methods used to evaluate were appropriate for the course in Glasgow but many are applicable to other courses in general practice in other Universities.
The teaching of general practice in the undergraduate medical curriculum now takes place in all medical schools in the United Kingdom. The main expansion has taken place after the Report of the Royal Commission on Medical Education in 1968. The teaching in general practice was introduced into already crowded curricula and it has therefore been important to justify this teaching. The developments at each University have been dependent on the local circumstances and this has led to a variety of teaching methods. The need for general practice teaching is discussed and this is followed by a description of the present teaching at all the Universities in the United Kingdom. Methods of evaluation have undergone recent changes and the methods used in this thesis are those that are accepted by educationalist. The undergraduate teaching of general practice presents difficulties in an evaluation. Firstly with the teaching being new, the literature is sparse on the subject and guide-lines are difficult to find. Secondly, almost all the teaching is carried out by full-time general practitioners; the students are in groups of two or four and observational data is impossible to obtain without a large team of evaluators. Thirdly, the teaching of general practice at present is not subjected to traditional examination techniques and therefore data cannot be compiled from that source. Traditional evaluation depended on measurable data and it is this which has had most criticism because it is too restrictive and misses the complexity of the teaching/learning situation. The current approaches give a more global view of the teaching but all evaluation procedures have advantages and disadvantages. In the present study a number of approaches have been used, utilising the advantages of the different methods and recognising some of the disadvantages. The teaching of general practice in Glasgow was expending during the time of study; some parts were developing while others were an established part of the teaching and these factors had to be taken in account when choosing methods of evaluation. The teaching in third year, when the student is present at a patient's initia1 consultation in a new illness, was introduced at the beginning of the present study. A pilot study was carried out to determine the feasibility and desirability of this teaching. As a result of this, the teaching was given in the following academic year to the majority of students in the year. Further evaluation was carried out and as a result this teaching is now an accepted part of the curriculum. Any innovation in general practice teaching in Glasgow will continue to be assessed in this way and will not be introduced into the curriculum unless it adds a further dimension to the hospital teaching. The opinions of both students and tutors are sought early and any alterations can be introduced at an early stage. The teaching in fourth year, the long-term care of the chronic sick, is an accepted part of the curriculum and the introduction of recording booklets allowed the teaching to be standardised and both the teaching and the students to be evaluated. The teaching in fifth year was at an early stage at the beginning of the present study and the methods chosen for evaluation were similar to those used in third year. The Department of General Practice in Glasgow introduced to the teaching of medical students the technology of a computer. This study was part of a National Programme and was an innovation in a British medical school. This new teaching method was evaluated and the print-outs of the students' performance which the computer could provide gave an additional method of evaluation. Computer-assisted learning is now being used in other Departments in the medical school and the teaching materia1 and methods are being transferred to other Universities. This teaching method has considerable application. In medicine and further development will continue. Any teaching method using high technology can be difficult to justify on an economic basis but in medicine with the high cost of training a doctor, this teaching can be cost-effective. The collaborative teaching with the hospital departments is at an early stage and seems to form a useful addition to the hospital teaching. This will expand and probably involve other disciplines. The senior elective as a formal part of the course was introduced for the first time during the period of evaluation. Although the number of students was limited, the format and the variety of practices have been appreciated. The tutor force continued to grow throughout the period of the study and a significant number of the general practitioners in the Glasgow area are now involved in this teaching. This large number of tutors creates problems in the uniformity of methods and standardisation of teaching. There are regular meetings with the tutors and evaluation data is presented with each tutor being given his own data when he is able to compare this to that of the group. These meetings with visits to the general practitioners in their own surgeries have helped to create a unity of purpose. The questionnaire to the University teachers of general practice in other centres and to the Glasgow tutors has shown that there is a greater uniformity of opinion about general practice teaching than had been realised. There was also little difference between the full-time University teachers and the part-time tutors in their opinions about teaching. In the teaching in third and fifth year, a record was kept of all the teaching consultations. This provided a record of conditions seen and allowed a comparison with the corresponding morbidity in a general practice situation. The student learning was measured in the third year and the opinions of those concerned were sought in both years. The detailed marking of the recording booklets and the computer print-outs provided the main basis for the evaluation in fourth year. The elective period was evaluated using a questionnaire and the tutors' opinions were gathered in each part of the teaching. The methods used to evaluate were appropriate for the course in Glasgow but many are applicable to other courses in general practice in other Universities.
Keywords
Medical education, Medical general practice, Educational evaluation, Medical general practice - Study and teaching